OrganizationActive
Colorado Department of Corrections
NPI 1033430442 · Exclusive Provider Organization · Pueblo, CO
Provider details
- NPI number
- 1033430442
- Entity type
- Organization
- Primary specialty
- Exclusive Provider OrganizationManaged Care Organizations
- Organization subpart
- No
- Authorized official
- Joanie Shoemaker, Director of Clinical Services(719) 226-4535
- License
- 19512 (CO)
Specialties & taxonomies
Managed Care Organizations
Practice location
1410 W 13th St
Pueblo, CO 81003-1961
Phone: (719) 583-5550
Fax: (719) 583-5525
Approximate (ZIP-level) locationGet directions
Mailing address
1410 W 13th St
Pueblo, CO 81003-1961
Other names (DBA / former)
- Doing business as
- San Carlos Correctional Facility
Registry dates
- Enumerated
- 2010-06-21
- Last updated
- 2010-06-21
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.